2018 EMPOWER MB600-IN18 Plan Details - HealthPocket


Individual Health Insurance (Obamacare)

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Monthly Cost



Benefits & Coverage

Plan Name
Plan Year
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Expanded Bronze
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$85 Copay
Specialist Visit
$170 Copay
Laboratory Outpatient and Professional Services
$40 Copay
X-rays and Diagnostic Imaging
$130 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans
$500 Copay after deductible
Deductible - Family
$13000 per group
Out-of-Pocket Maximum - Family
$14000 per group

Prescription drug coverage

Generic Drugs
$36 Copay
Preferred Brand Drugs
$85 Copay after deductible
Non-Preferred Brand Drugs
50.00% Coinsurance after deductible
Specialty Drugs
50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URL
Does this plan have access to a national provider network?
Is a referral required to see a Specialist?
Not Covered
Does this plan cover services outside plan service area?
Yes - Services are covered inside and outside the service area within the continental U.S.
Does this plan cover services outside the country?
Yes - Urgent/Emergent Only

Hospital services

Emergency Room Services
$500 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
$500 Copay per Stay after deductible
Inpatient Physician and Surgical Services
No Charge after deductible
Emergency Transportation or Ambulance Service
$150 Copay


Prenatal and Postnatal Care
$85 Copay
Delivery and all inpatient services for maternity care
$500 Copay after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$85 Copay
Mental/Behavioral Health Inpatient Services
$500 Copay per Stay after deductible
Substance use disorder outpatient services
$85 Copay
Substance use disorder inpatient services
$500 Copay per Stay after deductible

Medical Management Programs

Does this plan offer a wellness program?
Not Covered

Vision Coverage

Routine Eye Exam for Children
Eye Glasses for Children
Routine Eye Exam for Adults
Not Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental Care
Child Dental Coverage - Basic Dental Care
Child Dental Coverage - Orthodontia
Child Dental Coverage - Major Dental Care

Adult Dental Coverage

Adult Dental Coverage - Routine Dental Care
Not Covered
Adult Dental Coverage - Basic Dental Care
Not Covered
Adult Dental Coverage - Orthodontia
Not Covered
Adult Dental Coverage - Major Dental Care
Not Covered

Exclusions and Limitations

More Included Benefits
Other Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Durable Medical Equipment
Hospice Services
Routine Foot Care
Non-Emergency Care When Traveling Outside the U.S.
Dental Anesthesia
Diabetes Care Management
Accidental Dental
Allergy Testing
Diabetes Education
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Reconstructive Surgery
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Bone Marrow Transplant
Congenital Anomaly, including Cleft Lip/Palate
Off Label Prescription Drugs
More Limited Benefits
Skilled Nursing Facility
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Nutritional Counseling
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded Benefits
Bariatric Surgery
Cosmetic Surgery
Hearing Aids
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Abortion for Which Public Funding is Prohibited

What To Know

  • This is an ACA (Obamacare) compliant health plan.

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